Gerente de Reclamos de Salud

About the role

The Health Claims Manager at GLH Global will lead the claims, authorizations and medical case management for insured members, ensuring timely, technical and objective resolutions in line with policy conditions.

Key responsibilities

• Oversee the analysis of complex medical cases, interpret coverage, benefits and exclusions, and monitor each case to final resolution.
• Objectively determine claim eligibility, prepare and submit reconsideration requests to insurers when contractual and technical grounds exist.
• Communicate decisions clearly to agents and insureds, especially when the insurer’s decision is upheld.
• Maintain ongoing communication with agents, insureds and insurance companies, identifying opportunities to improve processes and service quality.

Required profile

• Proven experience in health insurance, medical claims or related fields.
• Strong knowledge of health insurance policies, coverages, exclusions, authorizations and claim procedures.
• Ability to objectively analyse medical and contractual cases and formulate well‑grounded positions.
• Excellent negotiation, decision‑making and communication skills in Spanish; English is a plus.
• Organised, service‑oriented with a sense of urgency.

Required skills

• Proficiency with office productivity tools and claim management systems.